Bunker Hill Community College-TS-Middle School Application

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TRiO Talent Search

TRiO Talent Search is a federally-funded program to motivate, expose, and prepare middle and high school students for postsecondary education. Services include but are not limited to academic advising, career exploration, college visits, and much more.

To apply for the TRiO Program, please return all of the following to the main office or TRiO:

*Completed application form, signed by both parent/guardian and student

*Proof of student residency/citizenship—this could include a copy of the student’s birth certificate, permanent residency card or other documentation proving legal citizenship or residency of the U.S. All of the information is kept confidential.

Hablamos Español

Puede llamar al (617) 466-5075.

Admission Application

The information required by this application is to determine the applicant’s eligibility for the BHCC-TRiO Talent Search Program.

The information received is kept confidential.

WRIGHT ACADEMY & BROWNE MIDDLE SCHOOL

Please return this form to the school’s main office. For questions, call 617-466-5075.

Please complete all items.

Date:

mm-dd-yyyy

School ID:

Grade Level (circle one):

Name

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone (please include the best number to reach the student)

(999)999-9999

This is

Other

Student/Parent email:

example@example.com

Birthdate:

mm-dd-yyyy

Gender:

Citizenship: Student is a

#A

If you are not a US Citizen, please write down your Permanent Resident ID number above and attach a copy of your Permanent Resident ID card to this application. If you don’t have a Permanent Resident card, a valid I-94 card issued by the US Department of Immigration might be acceptable. No application will be accepted without proper documentation.

Country of Birth:

Circle One:

Expected Middle School Graduation Year:

Home Room:

Guidance Counselor:

Ethnic Heritage:

To be completed by the student

1. Who recommended you for the TRiO Talent Search Program, and why do you think you were chosen?

2. Why would you like to participate in the TRiO Talent Search Program?

3. How can the TRiO Talent Search Program help you be successful in school?

4. Do you want to learn more about college? Why?

5. Are you an English Language Learner (ELL) student?

6. Do you have an IEP (Individualized Education Program)?

Student Signature

Date

mm-dd-yyyy

Student’s Name:

First NameLast Name

ID:

Parent/Guardian Name:

First NameLast Name

Parent Phone:

(999)999-9999

Relationship to student:

Other

Size of Family Unit

Household Income:

Please complete the statement below if your household income* equals or is less than the dollar amount next to your family size. *Use your taxable income from 2022—Form 1040

I verify that my family income for 2023 is within the guidelines for low-income eligibility (150% of the federal poverty level as published in the Federal Register) for the US Department of Education TRIO Programs.

Parent Signature

Does your household receive assistance from any of the following sources? (check all that apply)

Is the student a foster child or ward/dependent of the court?

PARENTS’ EDUCATION

Mother’s highest level of education:

Father’s highest level of education:

Student lives with

Other

REQUIRED PARENT/GUARDIAN AUTHORIZATION

By signing below, I authorize and certify the following:

1. I, at this moment, authorize Bunker Hill Community College TRiO-Talent Search Program to obtain copies of any of my child’s records, including attendance, progress reports/report cards, discipline reports, IEP, SAT/PSAT/ACT scores, MCAS scores, free/reduced lunch eligibility information, family contact information, student supervision and financial assistance records from educational institutions my child is attending now and from education institutions s/he attends in the future.

2. I also authorize the Bunker Hill Community College TRiO-Talent Search Program to use my child’s picture and video likeness in program publication materials (brochures, newspapers, websites, and displays).

3. Should my child require medical attention while participating in any program activities and I cannot be contacted, I consent to medical examination and treatment deemed necessary by an attending medical professional.

Student Allergies:

Other Special Conditions:

4. My signature below certifies my consent to statements 1-3 above and indicates that the information on this application is true, complete, and accurate to the best of my knowledge.

Parent/Guardian Signature

Date

mm-dd-yyyy

Admission Application

APPLICANT (STUDENT) INFORMATION

STUDENT ACADEMIC NEEDS ASSESSMENT

INCOME ELIGIBILITY